- Healthfirst (GA)
- …and departmental information, and adheres to local, state, federal and Healthfirst specific compliance and regulatory guidelines + Additional duties as assigned ... **Minimum Qualifications:** + High School diploma or GED from an accredited institution + Prior experience in a customer service environment + Working experience in a fast-paced environment + Proficient in Microsoft Office Suite applications including Excel,… more
- Healthfirst (NY)
- …business and technology Evaluate and recommend new technologies to best support Healthfirst initiatives Proven ability to interact at and communicate to all levels ... of an organization. Ability to demonstrate organizational, interpersonal, and communications skills along with the ability to manage shifting priorities are critical for success in this position Designs, develops, and maintains complex applications Develops… more
- Healthfirst (NY)
- …steps related to complex government regulations. + Collaborate with the Healthfirst Compliance department, oversees the implementation and effectuation of all plans ... requirements are met. + Be responsible for bringing pertinent items to Healthfirst Regulatory Change Management and seeing projects through to fruition to ensure… more
- Healthfirst (NY)
- …: + Architect and Design the Data Lakehouse: Lead the design and implementation of a scalable and secure Data Lakehouse on AWS, including data storage and compute ... layers. + Storage Solutions: Design and implement storage solutions using AWS services like S3, Iceberg, + Integrate relevant metadata from platform with data catalog and/or metadata management solutions. + Compute Resources: Architect and optimize compute… more
- Healthfirst (NY)
- …+ Serve as a trusted resource and subject matter expert (SME) in compensation programs, policies, and relevant compensation legislation. + Collaborate closely with ... the Head of Compensation and other members of the Total Rewards team to support day-to-day work and ad-hoc analysis as needed. + Under general direction, collaborate with HR Business Partners (HRBPs) and Talent Acquisition to craft competitive compensation… more
- Healthfirst (FL)
- …+ Oversee the enrollment process, ensuring timely and accurate processing of new and modified enrollments, renewals, and terminations. + Collaborate with internal ... teams (eg, sales, customer service, compliance) to ensure seamless management of members. + Monitor ,report, and deliver updates on memberships, data integrity and address discrepancies related to member eligibility and enrollment. + Manage premium billing… more
- Healthfirst (NY)
- …+ Leverage leading analytical tools to generate insights that facilitate key decisions by department leadership + Create accurate reports or insightful and ... user-friendly dashboards that meet stakeholders needs and lead to business insights + Identify and monitor cost and utilization trends and the root causes in health plan trend performance, providing recommendations for solutions + Utilize statistical tools to… more
- Healthfirst (NY)
- …utilization, and quality data + Partner with departments across Healthfirst , including Medical Management, Population Health, Clinical Quality, Delivery Systems ... with community partners, state agencies, and provider organizations + Represent Healthfirst on local, state, and industry workgroups, helping to shape behavioral… more
- Healthfirst (NY)
- …that may be required or assigned. **Minimum Qualifications** + Experience working in an Agile environment as a Product Owner + Experience and track record of success ... directing the efforts of developers as a project manager or product owner in a deadline-driven and fast-paced environment + Ability to juggle multiple projects and tasks. Demonstrated knowledge of project management concepts (preferably Agile/SCRUM) + Hands on… more
- Healthfirst (NH)
- …+ Advocates, informs, and educates beneficiaries on services, self-management techniques, and health benefits. + Conducts assessments to identify barriers and ... opportunities for intervention. + Develops care plans that align with the physicians treatment plans and recommends interventions that align with proposed goals. + Generates referrals to providers, community-based resources, and appropriate services and other… more
- Healthfirst (FL)
- …that may be required or assigned **Minimum Qualifications** + Experience working in an Agile environment as a Product Owner + Experience and track record of success ... directing the efforts of developers as a project manager or product owner in a deadline-driven and fast-paced environment + Ability to juggle multiple projects and tasks. Demonstrated knowledge of project management concepts (preferably Agile/SCRUM) + Hands on… more
- Healthfirst (Enfield, NY)
- …in assigned territories. Special focus on reaching the Asian community in the Healthfirst service area (NYC). + Identify opportunities to tell the stories created by ... partnerships and relationships + Demonstrated professionalism in public spheres to represent Healthfirst in the target communities + Must be willing and able to… more
- Healthfirst (NY)
- …In the Clinical Performance Optimization team, you will work with process improvements, project go-lives, and reporting/analytics. This is a critical team that will ... provide insight across various programs and lines of businesses across the company. Duties & Responsibilities: + Enhance program management/project management tools and reporting + Create portfolio level reporting across teams + Learn business areas and create… more
- Healthfirst (NY)
- …+ Assists in the development of strategic plans to ensure modern and efficient claims processing across the entire lifecycle with a focus on a unified, streamlined ... experience for both providers and operations staff + Works closely with technology and business leadership to support the evolution and operation of a variety of digital claims capabilities on our modernization roadmap + Analyzes project needs and determines… more
- Healthfirst (NY)
- …+ Manages FCC Team Leads by providing coaching, development, and support to build effective and engaged field teams + Monitors team performance, addresses resource ... needs, and ensures consistent execution of care coordination workflows and protocols + Analyzes and presents team performance data, productivity metrics, and quality indicators to departmental leadership + Collaborates with Team Leads to address and resolve… more
- Healthfirst (NY)
- …timeliness, accuracy, and consistency. + Coordinates and communicates with Healthfirst Care Management teams regarding clinical eligibility issues, necessary service ... Director in directing, training, and developing team members by embodying the Healthfirst Trailblazer mindset and leading others by example. + Builds and develops… more
- Healthfirst (NY)
- …changes in regulations, recent training sessions, changes in workflow, and changes to Healthfirst benefits. Required on a routine basis to achieve a passing score on ... audits. When summoned by the Special Investigation Unit (SIU) of Healthfirst you will be adequately prepared, forthcoming with information and cooperative… more
- Healthfirst (MS)
- …+ Plays a leadership role in the definition and execution of the Information Management roadmap. + Supports Data Architecture roadmap by managing architectural runway ... for enterprise data model, enterprise data store/warehouse, information management, and advanced data analytics capabilities. + Provides data architecture thought leadership to cross-functional teams in the areas of advanced data techniques, including data… more
- Healthfirst (NY)
- …+ Lead a team of technical managers and engineers to build highly scalable solutions + As a leader, you will help develop Hyphens products and mentor other ... engineering managers and team members in the process + You will collaborate with other engineering teams, and work autonomously to maintain existing products and participate in new initiatives + Work with leadership across teams to plan new projects and… more
- Healthfirst (NY)
- …+ Coordinates and manages marketing, educational, and ad hoc material reviews including assisting the Regulatory Affairs Manager by reviewing, finalizing, submitting, ... and tracking approvals of material reviews in HPMS. + Actively participates in the annual Medicare Go to Market process, including working with internal stakeholders on developing significant marketing documents, assigning material IDs, and tracking… more